Sociodemographic and Maternal Determinants of Postnatal Care Utilization: A Cross-Sectional Study.

Introduction: Postnatal care (PNC) is critical for the newborn and the mother, as it offers the opportunity to examine the mother and child to ensure early and timely intervention of any obstetric anomalies that might have gone unnoticed during delivery. However, there is a lack of data on PNC utilization and associated determinants in Ghana. Meanwhile, it is suspected that the PNC service should be more patronized by mothers, particularly within the first 2 days after delivery; therefore, investigating PNC utilization and associated factors could inform policies to enhance PNC uptake. Objective: The objective is to determine the level of utilization of PNC service and associated factors in the Savannah region of Ghana. Methods: The study used a facility-based analytical cross-sectional study design. The study was carried out in 311 postnatal mothers using consecutive sampling. Data collection was carried out using a questionnaire. Univariate and multiple logistic regression was performed to establish the determinants of PNC. Variables/variable categories with P < .05 were significantly associated with PNC. The significance level is anchored at P < .05. Results: The study showed that almost all respondents (98.7%) have heard about PNC services through health workers (39.7%), media (13.0%), and friends and relatives (47.2%). Most of the respondents (88.7%) have used PNC services within 48 h. Mothers aged 25-39 years were about seven times more likely to utilize PNC compared to those who were less than 25 years old (AOR [adjusted odds ratio] = 7.41, 95% CI [confidence interval]: 1.98-7.71); mothers with high school education (SHS) and above were also approximately four times more likely to use PNC compared to those who had no formal education (AOR = 3.65, 95% CI 1.97-13.66). In the same vein, married mothers were 10 times more likely to use PNC compared to those who are single mothers (AOR = 10.34, 95% CI: 3.69-28.97), whereas mothers who had at least four antenatal care (ANC) visits during pregnancy were approximately seven times more likely to use PNC compared to those who had less than four ANC visits (AOR = 6.92, 95% CI: 1.46-32.78). Reasons for not attending PNC include waiting time (40.5%), health workers' attitude (32.4%), being attended by a student (16.2%), being busy (27.0%), inadequate information on PNC (24.3%), and no family support (18.9%). Conclusion: All mothers knew about the PNC services, with a higher proportion patronizing the services. The increasing age, the level of mothers, marital status, and participation in ANC were significant determinants of the use of PNC. More education during ANC on the importance of PNC service is required to achieve universal coverage of PNC.

Ghana health service performance appraisal system: a cross-sectional study on practices and perceptions among employees in the Bono East Region of Ghana, West Africa.

Introduction: the fulcrum of every organization lies in the productivity of its employees. Consequently, organizations have adopted a policy of fostering an organizational culture that promotes employee development, resulting in the consistent use of performance evaluation systems particularly, performance appraisals (PA). Nonetheless, the issue of concern for several organizations is whether PA will truly be an adequate tool for maximizing employee´s performance. Here is where it becomes important to gauge the perceptions and practices of Ghana Health Service (GHS) employees in the Bono East Region of Ghana, West Africa, towards these performance appraisal systems (PAS). Methods: the study used an institutional-based cross-sectional study. Using simple random sampling, 375 health workers were recruited using a structured questionnaire. Data was analyzed using Stata. Bivariate and multivariate logistic regression analysis was performed and p-value less than 0.05 was considered statistical significance. Results: the study revealed that the majority of the respondents (86.7%) had completed the performance appraisal form. Out of which 47.7% complete and submit PA every year, followed by those who complete and submit during promotion time (24.3%), every half year (15.1%) and anytime (12.9%). The key determinants of PA completion include; increasing age (AOR=2.24, 95% CI: 1.08-4.62), male staff (AOR=2.38, 95% CI: 1.16-4.91), permanent GHS employees (AOR=2.9, 95% CI: 1.07-7.86), respondents who had worked for 3 to 7 years (AOR=5.53, 95% CI: 2.48-12.36) and those with over 7 years working experience (AOR=20.80, 95% CI: 5.43-79.74). Conclusion: the study identified that the majority of the respondents completed PA, but quite an encouraging number of them do not complete PA at the required period as expected. Age, male staff, permanent employment, and increasing years of experience were the significant predictors of PA completion. Continuous professional development for GHS staff on PAS is required. The GHS human resource division should organize stakeholders´ engagement with facilities managers and employees on the PAS to inform all managers and employees on what is required from everyone.

Risk factors for COVID-19 virus infection among health workers: A case-control study in the Bono East Region of Ghana.

BACKGROUND: Disproportionately high rates of COVID-19 infection among health workers prompts the need to identify the risk factors to help guide the design and implementation of interventions. The aim of this study was to characterize the risk factors for COVID-19 infection among health workers. METHODS: A case-control study was designed to recruit 154 health workers who tested positive for the COVID-19 virus and 308 who tested negative from 8 hospitals and 11 health directorates in the Bono East Region of Ghana. Crude and adjusted logistic regression analysis was used to determine risk factors. RESULTS: Hand hygiene compliance for the recommended moments ranged from 55.3% to 77.4%. Personal protective equipments (PPE) use was 59.5% when patients' COVID-19 status was unknown and at least 90.7% when patient was positive. We identified years of practice experience (adjusted odds ratio (AOR) = 1.81; 95% CI: 1.07, 3.07; P = .028), adherence to infection prevention and control (IPC) when in contact with patients whose COVID-19 status is unspecified (AOR = 1.71; 95% CI: 1.09, 2.70; P = .020) and type of facility (AOR = 1.69, 95% CI: 1.09, 2.62; P = .019) as risk factors. CONCLUSION: The findings underscore the need for health workers to improve in COVID-19 risk perception.

Cardiometabolic Risk Factors and Preclinical Target Organ Damage Among Adults in Ghana: Findings From a National Study.

Background Although sub-Saharan Africa has a high prevalence of cardiovascular diseases (CVDs), there remains a lack of systematic and comprehensive assessment of risk factors and early CVD outcomes in adults in sub-Saharan Africa. Methods and Results Using a stratified multistage random sampling method, we recruited 1106 men and women, aged >18 years, from the general population in Ghana to participate in a national health survey from 2016 to 2017. In Ghanaian adults, the age-standardized prevalence of known CVD risk factors was 15.1% (95% CI, 12.9%-17.3%) for obesity, 6.8% (95% CI, 5.1%-8.5%) for diabetes mellitus, 26.1% (95% CI, 22.9%-29.4%) for hypertension, and 9.3% (95% CI, 7.1%-11.5%) for hyperuricemia. In addition, 10.1% (95% CI, 7.0%-13.2%) of adults had peripheral artery disease, 8.3% (95% CI, 6.7%-10.0%) had carotid thickening, 4.1% (95% CI, 2.9%-5.2%) had left ventricular hypertrophy, and 2.5% (95% CI, 1.5%-3.4%) had chronic kidney disease. Three CVD risk factors appeared to play prominent roles in the development of target organ damage, including obesity for peripheral artery disease (odds ratio [OR], 2.22; 95% CI, 1.35-3.63), hypertension for carotid thickening (OR, 1.92; 95% CI, 1.22-3.08), and left ventricular hypertrophy (OR, 5.28; 95% CI, 2.55-12.11) and hyperuricemia for chronic kidney disease (OR, 5.49; 95% CI, 2.84-10.65). Conclusions This comprehensive health survey characterized the baseline conditions of a national cohort of adults while confirming the prevalence of CVD risk factors, and early CVD outcomes have reached epidemic proportions in Ghana. The distinct patterns of risk factors in the development of target organ damage present important challenges and opportunities for interventions to improve cardiometabolic health among adults in Ghana.

Characteristics of Inpatient Hypertension Cases and Factors Associated with Admission Outcomes in Ashanti Region, Ghana: An Analytic Cross-Sectional Study.

BACKGROUND: Hypertension remains a cause of morbidity and mortality in the Ashanti Region of Ghana. It has been featured in the top ten causes of OPD attendance, admissions, and deaths since 2012. We investigated the sociodemographic characteristics and spatial distribution of inpatient hypertensives and factors associated with their admission outcomes. METHODS: A 2014 line list of 1715 inpatient HPT cases aged ≥25 years was used for the cross-sectional analytic study. Accounting for clustering, all analyses were performed using the "svy" command in Stata. Frequencies, Chi-square test, and logistic regression analysis were used in the analysis. Arc view Geographic Information System (ArcGIS) was used to map the density of cases by place of residence and reporting hospital. RESULTS: Mean age of cases was 58 (S.D 0.0068). Females constituted 67.6% of the cases. Age, gender, and NHIS status were significantly associated with admission outcomes. Cases were clustered in the regional capital and bordering districts. However, low case densities were recorded in the latter. CONCLUSION: Increasing NHIS access can potentially impact positively on hypertension admission outcomes. Health educational campaigns targeting men are recommended to address hypertension-related issues.

Variations in levels of IL-6 and TNF-α in type 2 diabetes mellitus between rural and urban Ashanti Region of Ghana.

BACKGROUND: A surge in pro-inflammatory markers, Il-6 and TNF-α, has been associated with type 2 diabetes mellitus (T2DM). However, there is no data on the dynamics of these markers in T2DM Ghanaian populations. The aim of this study was to determine variations in the levels of IL-6 and TNF-α in T2DM patients. This study also examined the associations of IL-6 and TNF-α with anthropometric measurement and the effect of co-morbidity with hypertension using rural and urban dwellers in the Ashanti region, Ghana. METHODS: A nested case-control design using participants aged 25-70 years consisting of 77 T2DM ± hypertension patients and 112 controls were selected from a larger study on Research on Obesity and Diabetes among African Migrants (RODAM). Anthropometric measurements, blood pressure and body fat percentage were measured. Fasting blood samples were analyzed for glucose, IL-6 and TNF-α levels. RESULTS: The median level of IL-6 was significantly higher (p < 0.0001) among rural dwellers compared to urban dwellers. Inversely, urban dwellers had significantly higher (p = 0.0424) median level of TNF-α compared to rural cases. No significant differences were observed in IL-6 (p = 0.3571) and TNF-α (p = 0.2581) among T2DM patients compared with T2DM ± hypertension patients. A weak negative correlation was found between IL-6 and BMI in urban T2DM. DISCUSSION: The average level of IL-6 was higher in rural T2DM participants compared with those in urban setting. However, higher levels of TNF-α was observed among the study participants with T2DM in urban settings compared to those of rural. In this study, we observed that co-morbidity of hypertension had no significant effect on the levels of IL-6 and TNF-α. We are of the opinion that higher physical activity levels among rural particpants and high obesity levels in urabn participants explain the observation but needs more numbers to validate. CONCLUSION: This study revealed that IL-6 levels were higher among rural dwellers than urban while TNF-α levels were higher in urban dwellers than rural in patients with T2DM. There was no association of body fat percentage and body mass index with IL-6 and TNF-α levels. Co-morbidity of hypertension with T2DM had no effect on IL-6 and TNF-α levels.